Neuro Flashcards
1
Q
The most common cause of viral encephalitis is…
A
herpes simplex virus type 1 (HSV-1).
2
Q
what area of the brain does viral encephalitis typically affect and how does this present
A
temporal and inferior frontal regions of the brain.
presents with Sx such as focal neurological deficits e.g. aphasia
behavioural changes
herpes infection can cause visual changes on MRI in these regions
3
Q
RFs for IIH
A
obesity
4
Q
presentation of diabetic peripheral neuropathy
A
glove and stocking distribution of neuropathic pain and/ or loss of sensation.
5
Q
what parameter is used to monitor respiratory effort in neuromuscular conditions such as myasthenia gravis AND why
A
Forced Vital Capacity (FVC) is the gold standard parameter to monitor in patients with breathing difficulties with a background of neuromuscular conditions as it can pick up early respiratory muscle dysfunction
6
Q
serology blood tests for myasthenia gravis
A
acetylcholine receptor (anti-AChR) antibody
muscle-specific tyrosine kinase (anti-MusK) antibodies
7
Q
Ix for myasthenia gravis
A
- serology for AChR + anti-MusK
- serial nerve conduction studies
- CT imaging looking for thymoma which produces the antibodies.
8
Q
when should you consider mechanical ventilation for a pt with myasthenia gravis
A
If the forced vital capacity is 15 mL/kg or less, the patient should be considered for mechanical ventilation.
9
Q
MX for myasthenia gravis
A
1st line =
Pyridostigmine: acetylcholinesterase inhibitor.
2nd line =
immunosuppression: steroid or azathioprine
10
Q
when investigating MS why do you measure oligoclonal bands in CSF and serum
A
to compare the levels between the 2.
if raised in both this suggests systemic inflammation that is being resolved.
if raised only in the CSF this suggests intrathecal production and therefore primary or secondary inflammation in the brain or spinal cord
11
Q
huntingtons Sx
A
triad:
- Choreoathetosis: Unpredictable, flowing, and writhing movements
- Cognitive impairment: Dementia, often marked by problems with judgment, memory, and other cognitive functions
- Psychiatric abnormalities: Depression, irritability, apathy, and sometimes psychosis
12
Q
inheritance pattern of huntington’s disease
A
autosomal dominant
13
Q
A right sided inferior homonymous quadrantanopia is produced when…
A
there is damage to the optic radtion where it passes through the parietal lobe on the contralateral side of the visual field loss
In this case on the left
14
Q
typical presentation of peripheral neuropathy
A
distal sensory loss and diminished reflexes while motor power is preserved
15
Q
what class of drug is selegiline
A
MAOI-b
16
Q
1st line Mx for Parkinson’s not causing functional impairment or ↓ QoL
A
dopamine agonists: ropinarol, rotigotine or pramipexole
17
Q
1st line Mx for Parkinson’s causing functional impairment or ↓ QoL
A
levodopa + decarboxylase inhibitor
18
Q
key features of normal pressure hydrocephalus
A
wet, wacky + wobbly
- urinary incontinacne
- dementia
- gait inastability / magnetic gait
19
Q
SAH investigations
-imaging and Bloods
A
- non-contrat CT head - shows spider shaped hyperdensities
- CT angiography to identify aneurisms or vascular malformations that could have caused the bleed
- FBC + clotting screen
- LP if CT is -ve but suspicion remains. shows xanthochromia = bilirubin is CSF due to RBC breakdown. must wait 12 hours - not reliable before.
20
Q
SAH Mx
A
- Neurosurgery for endovascular coiling [surgical clipping=2nd line].
- Nimodipene to prevent vasospasm –> vasospasm-induced cerebral ischaemia
21
Q
cause + Sx of spinal caludication
A
- spinal stenosis - narrowing of the spinal canal which the spinal crd travels through.
- Leg pain and weakness that worsens with physical activity and is relieved by rest, accompanied by numbness, tingling, and decreased sensation or strength in the lower extremities
22
Q
location + function of brocas area
A
- inferior frontal gyrus of the dominant hemisphere
- production of speech
23
Q
location + function of Wernicke’s area
A
superior temporal gyrus of the dominant hemisphere
- understanding of speech
24
Q
lacunar strokes Sx
A
contralateral Sx:
- pure motor stroke
- pure sensory stroke
- pure sensorimotor stroke
- clumsy hand syndrome
- ataxic hemiparesis
25
MC type of partial seizure
temporal lobe epilepsy
26
temporal epilepsy Sx
- auras: rising abdominal pain, deja vu, auditory or visual hallucinations. Occur 1-2 mins before loss of consciousness.
- automatisms: e.g. lip smacking
- post-octal amnesia.
27
MC cause of vertigo
BPPV>> Menieres disease >> Labyrinthitis.
28
different causes of vertigo
* BPPV: Short duration of vertigo on head perturbation
* Meniere’s disease: Vertigo lasts hours and is always accompanied by tinnitus: hearing loss, and fullness in the ear
* Labyrinthitis: Preceding viral infection with vertigo and hearing loss lasting days
* Vestibular neuritis: Preceding viral infection with vertigo lasting days, NO hearing loss
* acoustic neuroma
29
first-line treatment treatment of focal seizures
Leviteracetam or Lamotrigine
30
Tx for absence seizures
Ethosuximide is used to treat absence seizures
31
RFs for subdural haemorrhage and why
older age and alcohol use, as these both cause brain atrophy, which stretches the veins
32
Gold standard Ix for MS
MRI with contrast as it can show dissemination in time or space for the McDonalds criteria.
33
A bilateral facial nerve palsy with weakness involving all muscles, including the forehead, is commonly caused by
Borrelia burgdorferi infection following a tick bite
Lyme disease
34
sudden onset of dizziness or unsteadyness without focal deficits. query what
posterior circulation stroke
35
what happens at TIA clinic
CT head
start aspirin
carotid doppler
MRI head - to show ongoing infarction = gold standard imaging to Dx stroke
24hr ECG
after this either start dual antiplatelets or a DOAC if AF is present.
Mx BP
36
define a crescendo TIA
more than 1 TIA in 7 days
37
when do you intervene for carotid stenosis and within what time frame
>70% stenosis on the side of the stroke
within 2 weeks
38
TIA causes infarction T/F
False
you only see ischaemia as the clot moves on.
39
blurring of right eye + numbness gradually increasing from left hand to lip - followed by headache
migraine with aura
stroke mimic
40
GCS of 8 can affect
airway --> resp dysfunction
need to inform ICU / anaesthetics
Intub8
41
define an aneurism
abnormal dilatation of the artery + weak arterial wall.
high risk of rupture and haemorrhage
42
classic Sx of acoustic neuroma
- Unilateral sensorineural hearing loss (often the first symptom)
- Unilateral tinnitus
- Dizziness or imbalance
- A sensation of fullness in the ear
43
Horner syndrome Sx
1. Ptosis: Drooping of the upper eyelid
1. Miosis: Constriction of the pupil
1. Anhidrosis: Lack of sweating on the affected side of the face
Also:
- dizziness
- headache
- neck pain - red flag indicative of carotid artery dissection
44
Horner syndrome causes
- stroke
- tumour [pancoast]
- carotid arty dissection - MC in young pts and accompanied by neck pain.
- MS
- lung cancer --> damage to the second order neuron.
- stroke --> damage to the first order neuron.
- trauma/injury to the neck.
45
MC hereditary cause of peripheral neuropathy
- inheritance pattern
- Sx
Charcot-Marie-Tooth syndrome
- autosomal dominant
- distal muscle weakness, foot drop and decreased sensation
46
T/F
you should take sumatriptan once the aura starts
FALSE
Sumatriptan should be taken once the headache starts, but not during the aura phase
47
T/F
problems with speech production are always related to an infarction affecting Broca's area
FALSE
a cerebellar infarct can cause dysarthria -
48
what causes a lacunar stroke
small vessel disease affecting the perforating arteries, often within the internal capsule
49
additional Mx of meningitis besides Abx
- IV dexamethasone improves pt outcomes by limiting inflammation in the brain which reduces risk of death, hearing loss or neurological sequelae
- Tx of close contacts with one-off dose of oral ciprofloxacin 500mg
50
what is Parkinson-plus CBD and what are common Sx?
- cortico-basal degeneration
- Sx of Parkinson's triad [ tremor, rigidity + bradykinesia] PLUS spontaneous uncontrollable activity of an affected limb or akinetic rigidity = alien limb phenomenon.
51
a mid humerus fracture affects which nerve, why and causes what symptoms
- radial nerve
- it travels in the radial groove along the
- causes wrist drop due to weakness of wrist extension AND weakness of metacarpophalangeal joint extension of all digits.
52
categorisation of brain mets
Supratentorial: 80% are located above
Infratentorial: 20% are located below in adults. While 45-60% in kids.
53
1st line Mx for brain mets
- Steroids: dexamethasone to reduce oedema, to manage acute Sx
- followed with radiotherapy [general or localised stereotactic] Or surgery
54
which cancers MC metastasise to the brain
Lung
Breast
Renal cell carcinoma
Melanoma
55
cause and Mx of an acute dystonic reaction
- can be caused by dopamine antagonists e.g. metoclopramide or typical antipsychotics
- anti-cholinergic drugs e.g. procyclidine.
56
when is carotid endarterectomy indicated, routine and urgent
If doppler shows carotid stenosis of at least:
- 50% then carotid endarterectomy is indicated.
- 70% then urgent carotid endarterectomy is indicated.
57
visual sx in Ms
optic neuritis
- blurred/loss of vision +
- red desaturation +
- eye pain
- usually unilateral
- pale optic disc
58
driving rules after a seizure.
First unprovoked seizure: You must take 6 months off driving from the date of the seizure. If there is a high risk of further seizures, you must take 1 year off driving.
59
what duration of a migraine = status migrainosis
72 hrs
60
features of a non-epileptic attack
A: arms flexing and extending is a common feature of NEAs, as is pelvic thrusting
B: eyes are usually closed, which may also be the case in syncope; eyes are typically open in epilepsy
C: symptoms wax and wane in NEAs, as opposed to epilepsy, which typically follow set patterns (e.g. tonic-clonic)
D: prolonged seizures (often >30 minutes) are common in NEAs; epileptic seizures and syncope typically do not last >5 minutes
gradual onset and offset of seizure
no tongue biting or incontinence
normal serum prolactin.
61
name a feature of syncope
Gradually sinking to the ground at the start of the attack is usually a feature of syncope
62
radial neuropathy
causes:
- wrist drop
- sensory loss/ paraesthesia over the dorsumof the hand
- weakness in finger extension
63
median neuropathy
= carpal tunnel syndrome. Sx:
- sensory loss/ paraesthasia over median nerve distribution in hand
- weakness/ clumsiness of the hand and weak aBduction
- hand pain, typically worse at night.
64
3 options for migraine prophylaxis
- propranolol
- topiramate [teratogenic and very effective contraception is needed]
- amitriptyline
65
Classic triad of Wernicke’s
[not all signs must be present for Dx] =
1. Confusion / change in mental status
1. Ataxia
1. Nystagmus / ophthalmoplegia.
66
Hallmark signs of Korsakoff syndrome
- Limited retrograde amnesia [inability to access old memories]
- Profound anterograde amnesia [inability to form new memories] -->
- Confabulation (patients fabricate memories to mask their memory deficit)
67
Key Mx for wernickes encephalopathy + korsakoff syndrome
**THIAMINE SUPPLEMENTATION** - Pabrinex
**counselling and rehabilitation** for alcohol use disorders.
**Cognitive rehabilitation** in korsakoff to improve residual cognitive function and adapt to the memory loss and help maintain abstinence
68
driving rules for syncope
Drivers who experience one episode of unexplained syncope must inform the DVLA and must not drive for six months.
Multiple episodes of syncope = 12 month
driving ban.
69
which AED is used for:
1. focal sezures ± generalisation
[generalised]
1. myoclonic
1. tonic-clonic
1. tonic and atonic
1. absence
1. lamotrigine
generalised
1. levetiracetam
1. lamotrigine or levetiracetam
1. lamotrigine
1. ethosuxamide
70
B12 deficiency causes
Subacute combined degeneration of the spinal cord is due to vitamin B12
deficiency resulting in impairment of the dorsal columns, lateral corticospinal tracts
and spinocerebellar tracts.
sx:
- peripheral paraesthesia
- muscle weakness
- brisk reflexes + upping plantar reflex.
71
brown sequard syndrome clinical features
hemisection of the spinal cord
- Ipsilateral spastic paralysis below the level of the lesion
- Ipsilateral loss of fine touch, proprioception and vibration sense
- Contralateral loss of pain and temperature sensation
72
1st line mx for bone and brain mets
dexamethasone
73
long term complications of caudal equine syndrome
- Paraplegia
* Lower limb numbness
* Chronic urinary retention or incontinence
* Chronic sexual dysfunction
74
orthostatic syncope is caused by and characterised by?
orthostatic
hypotension, which results in a temporary reduction of cerebral blood flow
when standing up, leading to syncope.
This is characterized by a drop in
blood pressure and heart rate, causing a brief episode of loss of
consciousness.
75
vasovagal syncope
common and often occurs in response to stress, fear, or pain,
leading to a sudden drop in heart rate and blood pressure.
76
first test you order in suspected epilepsy
blood glucose as a hypo can act as a mimic
77
epilepsy Ix
GS = MRI head to rule out structural changes
EEG
ECG
bloods: CRP/ESR, U+E BLOOD GLUCOSE
78
Sx of opioid withdrawal
nausea/vomiting,
myalgia,
sweating,
chills/hot flushes,
diarrhoea,
anxiety,
irritability,
depression/low mood,
yawning,
watering eyes,
rhinorrhoea,
tremors,
piloerection/goosebumps
79
GCS Score
MoVE 654
- 15 = best score
- 8 = intubate
- 3 = comatose
80
levodopa side effects
central SEs:
* Drug induced dyskinesia
* end of dose effects
* on-off phenomena
* Psychosis
peripheral SEs:
* Nausea and vomiting
* Postural hypotension
* Cardiac arrhythmias
[Neuroleptic malignant syndrome [if suddenly stopped]]
